Biologic Drugs
Injectable Medications For Treating Rheumatoid Arthritis

Rheumatism


women receiving biologic drugs
Women receiving intravenous infusion of biologic drugs at clinic.

Biologic Drugs

Contents

What Are Biologic Drugs?
List Of Biologic Medications
Are All Biologics Injected?
How Do They Work?
How Quickly Do They Work?
Which Biologic Drug Is Best?
What Are The Side Effects?
Can Pregnant Women Take Biologics?
When Are They Not Suitable?
How Much Do They Cost?



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Rheumatoid Arthritis Guide
What Are Biologic Drugs?

They are injectable medications that contain powerful ingredients which have revolutionized the treatment of rheumatoid arthritis. Sometimes called biologic DMARDs (Disease-Modifying Antirheumatic Drugs) or just, biologics, they do not cure rheumatoid arthritis, but they do reduce symptoms and may help prevent joint damage. On the downside, they are very expensive and can cause serious side effects, so biologics should not be prescribed until all other conventional rheumatoid arthritis medications have been tried. That includes ibuprofen, corticosteroid injections and nonbiologic DMARDs such as Plaquenil, Azulfidine, Minocin and Dynacin. Between 40 and 70 percent of patients who do not experience enough symptom-relief with these medications, will do so with biologics. To date, only about 600,000 people worldwide have taken biologics.

Note: Biologics are also used in the treatment of psoriasis, psoriatic arthritis, juvenile arthritis, Crohn’s colitis and ankylosing spondylitis.

List Of Biologic Medications

Generic Name Brand Name Type Of Injection Frequency
Abatacept Orencia Intravenous Every 4 weeks
Anakinra Kineret Injection Every day
Adalimumab Humira Injection Every second week
Certolizumab Cimzia Intravenous Every 4 weeks
Etanercept Enbrel Injection Once a week or every second week
Infliximab Remicade Intravenous Every 8 weeks
Rituximab Rituxan Intravenous 2 infusions separated by 2 weeks. Treatment repeated after 24 weeks if new symptoms appear.
Golimumab Simponi Injection Every 4 weeks
Tocilizumab Actemera Intravenous Every 4 weeks

Note: Injection means you can inject yourself (subcutaneously) with a prefilled injection pen. Intravenous injections need to be given in a doctor's office.

Are All Biologics Injected?

Yes. Some have to be administered by a healthcare worker into the vein in the arm (intravenously), while others can be self-injected under the skin (subcutaneously), like insulin injections for diabetics. Which type of injection you need, and how often, depends on the drug you have been prescribed (see chart above). If you are not comfortable with self-injecting, talk to your doctor about an intravenous medication.

How Do They Work?

Biologics are chemical agents that are designed to prevent or reduce inflammation in the joints. The exact cause of rheumatoid arthritis is unknown, but it is thought to be the result of a faulty immune system. The immune system turns against the body and attacks healthy joints and tissues (this is called autoimmunity). There are lots of different types of autoimmune diseases - with rheumatoid arthritis it results in the tissues inside the joints being attacked, causing inflammation and ultimately destroying the joint itself. Biologics help by blocking certain actions in the immune system, so that misdirected attacks occur less frequently. The downside however is that a suppressed immune system will make the patient prone to all sorts of infections.

There are several different types of biologics, each targets a specific step in the inflammation process. Enbrel, Simponi, Cimzia and Humira are called TNF blockers. They block the work of chemicals called cytokines which promote inflammation. Anti-TNFs (as Enbrel etc are known) are usually taken with methotrexate (a non-biologic DMARD). Kineret blocks interleukin-1 but is generally seen as less effective. Rituxan reduces B cells in the body, but is reserved for those who do not experience good results from a TNF blocker. Orencia interrupts the activation of T-cells, but again is reserved for those who don't respond to anti-TNFs.

How Quickly Do They Work?

Some studies show that patients report improved symptoms within 4 to 6 weeks of treatment. But most patients taking Remicade, Enbrel or Humira notice significant improvement after the first or second injection.

Which Biologic Drug Is Best?

Studies indicated that the following 3 drugs are as effective as, or better, than the others at relieving rheumatoid arthritis symptoms. They also have fewer side effects:

• Adalimumab (Humira)
• Abatacept (Orencia)
• Etanercept (Enbrel)

What Are The Side Effects?

The vast majority of people (as many as 97 percent) taking biologics experience at least one side effect. These can range from the minor to more serious life-threatening disorders.

Mild Side Effects

• Headaches
• Nausea
• Tummy pain
• Reactions at the site of injection (when injected subcutaneously). Anakinra appears to cause the most reactions.
• Diarrhea
Because biologics target the defense system of the body, this can make you prone to minor infections, including:
• Respiratory infection
Urinary tract infections (UTIs)

Serious Side Effects

• Cancer: particularly bone marrow, lymph nodes and skin cancers
• Allergic reaction to the drug resulting in fever, chills and even convulsions
• Serious infections such as tuberculosis (TB) and other fungal infections
• Liver damage
• Damage to red blood cells

Reducing Your Risks

To reduce your risk of side effects, let your doctor know if you have:
Diabetes
Congestive heart failure
• A history of infections.
• Viral hepatitis
• Chronic obstructive pulmonary disease
• TB, or ever had TB.
• Been around someone with shingles, TB or chickenpox. Or if you are scheduled to receive a vaccination or surgery.

Can Pregnant Women Take Biologics?

The risk to unborn babies has not yet been established. For this reason, if you are planning on having a baby, you should not take biologics.

When Are They Not Suitable?

You should not be prescribed biologic if:

• You are pregnant
• Your arthritis is in remission
• You have not tried standard drug therapy (specifically non biological DMARDs)
• You have an infection
• You have used biologics in the past and had a serious reaction

You may not be prescribed biologics if you have:

• Cancer
• TB
• Serious heart condition
• Repeated infections
• Lung fibrosis

How Much Do They Cost?

Biologics are expensive. The average monthly cost (if you are paying yourself with no insurance coverage) is between $1,600 and $2,800. Manufacturers of the drug insist the cost of producing the active biologic agent in the medication is very high, and hence the reason for the high cost of the drug to the end user.

  Related Articles on Rheumatism

For more on arthritic pain, see the following:

Diagnosis of rheumatoid arthritis: How is it diagnosed?
Risk factors for rheumatoid arthritis: Smoking and menstrual periods.
Bone and joint conditions: Compare symptoms.

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